Bulked up: Swollen prostate has to shrin

Women have some medical issues that men don't have to worry about: PAP smears and pelvic exams, mammograms, etc. But men do need testicular exams, and rarely, men can get breast cancer. The big issue for men by the age of 40 or 50 is the dreaded prostate exam. Is the prostate such a problem?

First let's get the pronunciation right: it's prostate, not prostrate, which means to lie down face forward. Prostate rhymes with estate, dictate, and Sharon Tate. As I once recited on TV, "If when you urinate you start to hesitate, it could be from a big prostate."

Fifty percent of men by the age of 50 have microscopic BPH (benign prostatic hyperplasia). 5.6 million American men require treatment for symptoms of BPH and by 2020 will be 11.2 million. Men have to urinate through the prostate, which is a gland that looks like an apple (Fugi, McIntosh, you pick). Due to the effects of testosterone, the prostate grows and can compress the urethra (the tube which goes through the center of the prostate where urine passes). Then men start to have problems peeing, called LUTS (lower urinary tract symptoms)

LUTS sounds like a figure skating jump. If you see me skating at the Charlottesville Ice Park, you can see me doing a triple Lutz– okay, a double Lutz– ok a single Lutz, but I started skating at a late age! Pee in someone with LUTS starts off as a slow stream and progresses to hesitancy (meaning you wait and wait before you can start to sing "Raindrops Keep Falling...") and dribbling after you're done.

The main reason men come to see the doctor for LUTS is nocturia, which means having to urinate three or more times after going to bed. Getting up every hour or two to urinate doesn't allow a person to sleep well, and so these men tend to be tired and cranky.

In BPH, the bladder starts to enlarge and becomes like Arnold Schwarzenegger: pumped up. To pump out the urine through a compressed urethra, the bladder (which is a muscle) basically goes through boot camp and bulks up. So now the pump-ti-tude bladder starts to spasm here and there to make the man want to pee more often, but the results are usually unsatisfying.

Now think about the squeezed urethra that doesn't allow passage, kind of like when you pinch a garden hose. EJD (ejaculation dysfunction) occurs in 59-78 percent of men with BPH. It appears EJD might be related to decreased sex drive in men, and it's more upsetting than we realize. Surveys have shown men are negatively affected by EJD, but they don't talk about it with their doctors.

Classic medicines called alpha-receptor blockers like Hytrin and Cardura work well, but there can be an interesting side effect– you stand up and faint. Because alpha blockers reduce blood pressure, one can get the "vapors" faster than Scarlett O'Hara on a hot summer day.

Aromatase receptor inhibitors fight testosterone conversion on the prostate to help shrink the prostate back to normal size. Proscar and Avodart also have an interesting side effect: hair growth. So not only could you urinate better, but you could also throw away the toupee and stand underneath a waterfall. It takes up to six months for effects to be noticed, and not everyone responds to them.

Uroxatral has been in use in Europe for over 16 years, and now it's available in the US. This alpha-receptor blocker doesn't have the same blood pressure-lowering effects as the older ones. Therefore, the FDA had approved its use with Viagra and Cialis (as instructed by your doctor). Also, Uroxatral doesn't have EJD problems seen with other alpha-receptor blockers.